The authors conducted a retrospective review of 1990 Health Care Financing Administration billing files (Medicare part B) examining outpatient mammography from 10 states.

“Black women had mammography less often than white women (9% compared with 15%). At each primary care visit level (1,2,3 or more visits), black women had mammography less often than white women (1 visit, 7% compared with 15%; 2 visits, 12% compared with 21%; and 3 or more visits, 12% compared with 20%). Even among women who had made at least one visit to a primary care physician, a deficit for blacks occurred in each income quintile (lowest quintile, 13% compared with 20%; low, 10% compared with 18%; middle, 12% compared with 18%; high, 10% compared with 19%; and highest, 12% compared with 22%) and in each state.”

“Although the number of visits made to the primary care physician does influence mammography use, it is not sufficient to overcome socioeconomic and regional differences in mammography use. These results suggest that the nature of primary care may vary within and among states and between black women and white women. For both races, an increased number of visits to a primary care physician was associated with greater mammography use. Even after the number of primary care visits was considered, however, the deficit in mammography use among black women persisted at each income level and in each state.”

“Research has shown that physicians are more likely to encourage older white women to have mammography than older black women. Alternatively, because black women have been shown to be less knowledgeable about mammography than white women, physicians may be unwilling or unable to spend the additional time necessary to educate black women about the importance of the procedure.”